POST-OPERATIVE CARE

Causes of Tachycardia
 Pain
 Myocardial Infarction
 Pulmonary Embolism
 Hypovolemia
 Withdrawal
 Sepsis

 Pulmonary Embolism

o Risk Factors
 Major surgery
 Immobility
o Prevention
 Pharmacologic DVT prophylaxis
 SCDS
o ABG
 Hypoxemia
 Hypocarbia
o Treatment
 Systemic Anticoagulation
 Decrease propagation of further clot both in the legs and lungs
 Decrease inflammatory response
  Myocardial Infarction- the coronary vessels are not perfusing enough oxygen
o Main goal is of preop workup is to predict and prevent MI
o Chest pain:
 May be atypical
 Masked by other surgical pain
o EKG.Troponin
o MONA Tx
o Statin reduces in-hospital mortaility
 Morphine, Oxygen, Nitrolycerin, and Aspirin
o Causes of Fevers:
 Atelectasis
 Pneumonia
 UTI
 DVT
 Foreign objects: Central Lines, drains, catheters, mesh, implants
 Surgical site infection/ deep surgical infection
 Intrabdominal abscesses
 Look at surgical wound, common site of surgical fevers

Etiologies of Hypoxia
 Poor inspiratory effort
 Atelectasis
 Pneumonia
 Pulmonary Embolism

*move to ambulate to avoid recumbent causes atelectatis

Desaturation
 Supplemental Oxygen
 ABG
 Chest X-ray

Mental Status Changes

 Is patient protecting her airway? And moving air?
 Were there neurological findings consistent with stroke?
 Was recent sedative/anxiolytics medications administered?

Adjunctive Studies
 ABG
 EKG
  CXR
 CT Head

Sometimes you might not have the diagnosis prior to initiating therapy

Consider pulmonary embolism in a patient who is hypoxic and hyperventilating (ABG shows
low carbon dioxide)